Dental Network Relations, Senior Analyst

CVS Health•Work At Home-Florida, FL

1d•$46,988 - $112,200•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Act as a primary resource for all dental products ( PPO, Medicare) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures. Act as the liaison with the Primary Care Dentists and Specialists nationally retaining providers within the PPO network. This includes managing termination and sale of practice requests and ensure compliance with termination obligations, and cost of care improvements. Maintain and strengthen provider relationships to ensure network stability. Negotiation of contract language and provider compensation. Timely response to correspondence from Provider offices, included, but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues. Documented resolution and follow through communicated to all parties. Presentation of PPO plan design, compensation process, claim submission, and referral policies during new office orientations and reorientations via the telephone. Knowledge of the competitive market and Aetna's relevant competitive position. Presentation of Aetna's electronic capabilities for dental providers to achieve Company goals and targets, promote all EDI initiatives.

Requirements

5 years of Experience such as Sales, Service, Dental Office and/or payor setting.
Strong verbal and written communication skills.

Nice To Haves

Experience in the dental field and knowledge of PPO and Medicare networks.

Responsibilities

Act as a primary resource for all dental products (PPO, Medicare) for providers, sales and marketing, and Dental Service Centers to aid in the achievement of Aetna Key Performance Measures.
Act as the liaison with the Primary Care Dentists and Specialists nationally retaining providers within the PPO network.
Manage termination and sale of practice requests and ensure compliance with termination obligations, and cost of care improvements.
Maintain and strengthen provider relationships to ensure network stability.
Negotiate contract language and provider compensation.
Respond timely to correspondence from Provider offices, including but not limited to termination requests, tax id changes, hold requests, claim reimbursement, system, directory accuracy and various contractual issues.
Document resolution and follow through communicated to all parties.
Present PPO plan design, compensation process, claim submission, and referral policies during new office orientations and reorientations via the telephone.
Demonstrate knowledge of the competitive market and Aetna's relevant competitive position.
Present Aetna's electronic capabilities for dental providers to achieve Company goals and targets, promote all EDI initiatives.